MEDICARE: DR. THOMAS MASELLA DMD

Medicare Provider Information

Scope of Practice

The following information about the specialty of the provider is available:

#	Taxonomy Code	Taxonomy	License Number	License Number State
1	122300000X	Dentist	08668	NJ

General Provider Information

NPI Number	:	1619198744
Entity Type Code	:	Individual
Provider Name (Legal Business Name)	:	DR. THOMAS MASELLA DMD

Provider Business Mailing Address
First Line	:	15 JOCINE DR
Second Line	:
City	:	FAIRFIELD
State	:	NJ
Zip	:	07004-1412
Country	:	US
Telephone Number	:	973-227-1674
Fax Number	:

Provider Business Practice Location Address
First Line	:	195 FAIRFIELD AVE
Second Line	:	SUITE #3A
City	:	WEST CALDWELL
State	:	NJ
Zip	:	07006-6424
Country	:	US
Telephone Number	:	973-226-3242
Fax Number	:	973-228-6169

Authorized Official
Title or Position	:
Name	:
Credential	:
Telephone Number	:

Provider Enumeration Date	:	05/02/2007
Last Update Date	:	07/08/2007

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